One of the most notable things so many of last year’s biggest health stories have in common is that they envision an increased role for shared decision-making in primary care. Some patients will want to receive few aggressive interventions at the end of life; others will want more. Some women will be fine with waiting until age 45 or 50 to get their first mammogram; others will still want to start at ...

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Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago. Are they right? First, let me say that in some instances they may be correct. It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon. The hospital is not always right ...

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The customer is always right, or so the saying goes. If you have ever worked in retail, you may have been frustrated by buyers who ransack neatly folded tables of sweaters and leave them strewn about like tornado wreckage. If you are in the food industry, you may be annoyed by a diner who complains his soup is too cold even as you see steam rising off the bowl. It can sometimes ...

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When I was a new attending, an older man came to see me as a new patient.  He had not seen a doctor in over thirty years and was experiencing worsening chest pain that first occurred when he walked upstairs but had progressed to pain at rest.  An electrocardiogram in the office showed signs of ischemia, and I advised him that I wanted to call an ambulance to take him ...

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"Donald passed away." We had been sitting in the chiefs’ office with a few of the attendings who had all had Donald (name changed to protect privacy) on their service at one time or another. Everybody exhaled a collective sigh, soaking in the sting of the knowledge of Don’s death; then, within a few seconds, everybody had smiles on their faces.  The smiles were born out of a personal experience with him in ...

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burnout Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right. We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get so f'd up so fast? Attention medical students and doctors: It’s not your fault. Burnout is physical and mental collapse caused by overwork. So why ...

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Would my white lab coat be better put to use when I carve the Christmas roast than when seeing patients? After all, we know that these coats can be covered with pathogens, including drug-resistant ones, which may be transmitted to patients. They are cleaned infrequently: In a survey of physicians, nearly 58 percent said they laundered their white coats monthly or never. Less than 3 percent washed them daily ...

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There are times, as a healer, I feel helpless. These are not just the moments when cancer consumes. I understand that the dread disease has yet been conquered, and there is still terrible loss.   This not when I refer a patient elsewhere; I know my limits. Rather, these are the times when I am trapped, ignored, and the result is needless suffering. In his classic, often quoted, 1942 short story, Runaround, ...

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Today so many physicians are not able to see pharmaceutical representatives (PRs).  However, PRs do serve as a great resource and finding a way to make their visits more efficient and focused is an objective we all need to strive for. I recall requesting an interview with Lou Holtz, then the head coach at Notre Dame, and was told by his secretary the date and time that the interview would take ...

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This New Year is the appropriate time to make a resolution: the occasion to link advance care planning with a spiritual legacy.  People all have deep-seated values and determinations of what they are willing to pay for, live for and die for, but few actually document these for caregivers or posterity. Beginning in 2016, Medicare will begin to reimburse physicians for end-of-life counseling. However, throwing taxpayer dollars at no-win situations is ...

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